Payment reform

As a result of process improvement efforts bolstered by robust information systems, the proportion of all inductions that lacked strong indications for clinical appropriateness fell from 28 percent to less than 2 percent. The project also resulted in decreases in both NICU admissions and cesareans, and Intermountain estimates that the elective induction protocol reduces health care costs in Utah by $50 million per year.

This legislation would alter the organization of and payment for maternity services by: creating a mechanism to deny Medicaid payment for elective deliveries before 39 weeks, bundling payment for the full episode of maternity care for low-risk women, enabling access to midwives and birth centers providing high-quality, high-value care, and developing standards and a certification process for “pregnancy care homes”

The Louisiana Birth Outcomes Project is a state-wide effort coordinated by the Department of Health and Hospitals. This multi-stakeholder initiative drew inspiration from the Transforming Maternity Care project and charged several interdisciplinary task forces with constituencies modeled after the five TMC stakeholder workgroups to determine critical steps for progress in four major areas: quality and safety, interconception care, behavioral health, and performance measurement.

This act addresses many of the recommendations put forth in the direction-setting Blueprint for Action, with provisions related to many of the Blueprint’s 11 focal areas, including performance measurement and leveraging of results; payment reform aligning incentives with quality; scope of covered services for maternity care; coordination of maternity care across time, settings, and disciplines; decision-making and consumer choice; and development and use of health information technology.

The collaborative is seeking to understand the reason for rising C-Section rates and possible modifiable factors leading to this rise. The collaborative believes that the variation among hospitals in cesarean, VBAC, and induction rates are affecting maternal and infant health across the state of Washington. To address these variations the collaborative is engaging agencies, hospitals, organizations, and the community to encourage birthing hospitals to collaborate and address issues such as inductions, trial of labor, appropriate admissions, and accessibility to vaginal births after cesareans. The first initiative uses the March of Dimes Toolkit and other resources to reduce early elective deliveries in the state of Washington.

Late last year, TMC Vision Team and Partnership Steering Committee member Suzanne Delbanco, PhD, was named Executive Director of Catalyst for Payment Reform, a collaboration among seven of the nation’s largest employers using their purchasing power to advocate for health care payment approaches that reduce costs and waste while spurring higher quality.